The present invention relates to surgical attachment of soft tissue to bone tissue, and particularly to a tool and method for its use in performing the Bankart repair procedure to reattach a torn shoulder joint capsule to the scapula.
Dislocation of a shoulder joint often results in connective tissue of the shoulder joint capsule being torn free from the rim of the glenoid cavity of the scapula. Resultant weakening of the joint often leads to recurrence of the dislocation. In a surgical procedure called the Bankart operation, muscle surrounding the shoulder joint is cut and moved aside to give direct access to the attachment of the shoulder joint capsule to the anterior rim, or labrum, of the glenoid cavity of the scapula. Three or four holes are made through the glenoid rim, and sutures are passed through the holes and used to attach a portion of the capsule to the scapula. The entire procedure is described in greater detail in such medical references as Campbell's Operative Orthopedics, published by the C. V. Mosby Company of St. Louis, Mo.
Using previously available tools and methods, it has been difficult to provide the necessary holes extending through the rim of the glenoid cavity. Such holes in the past have been made by use of hammered spikes, dental drills with offset heads, or pincers-like piercing instruments. Use of an offset drill is difficult because of the slippery surfaces into which the necessary holes must be drilled. There has, then, been no reliable, easy way to provide a passage for sutures through the anterior glenoid rim which leaves a dependably strong enough solid body of bone to which to attach a suture to reattach the joint capsule to the rim of the glenoid cavity. As a result, the Bankart procedure has been difficult to perform, even though it is often preferred because of the excellent results it produces.
Various ways of attaching soft tissue to bone have been described in the past for use particularly in other parts of the human body. For example, United Kingdom patent application GB No. 2147504A of Hourahane discloses an arcuate frame to which is attached a probe for insertion through soft tissue surrounding a knee joint, together with a drill guide, for providing intersecting bores in bones and inserting sutures through the bores to attach soft tissue to a bone. Another drill guide disclosed by Hourahane is useful for drilling intersecting holes in certain bones where points of the drill guide can be driven into the bone to stabilize the tool. The apparatus disclosed by Hourahane, however, is not well adapted for use in performing the Bankart operation, because of its large size and the thick layer of muscle and connective tissue which must be moved aside to gain access to the glenoid rim.
Asnis et al. U.S. Pat. No. 4,450,835 discloses a tool which may be used to guide in the drilling of intersecting bores, but there is no disclosure of how such a tool could be used for repair of a shoulder joint.
Mains et al. U.S. Pat. No. 4,421,112 discloses use of a drilling guide in connection with osteotomy of the tibia, in which converging bores are drilled, using a pin extending into an earlier drilled bore to hold a guide for a drill used to form the later bore.
Neufeld U.S. Pat. No. 4,381,770 discloses another drilling guide which is held in the required position for drilling a subsequent bore by a rod extending into an earlier drilled bore. The Neufeld disclosure relates to repair of a broken femur, however, and the drilling guide does not appear to be applicable to repair of a shoulder injury.
None of the above-mentioned previously-known devices or methods is particularly well adapted for use in performing the Bankart operation on a shoulder joint.
What is needed, therefore, is a tool useful for guiding a small drill to bore a passageway through the rim of the glenoid cavity of a scapula in order to provide a strong anchor point for attachment of the capsule of the shoulder joint to the scapula. Such a tool must be useful in the restricted amount of space available in the vicinity of the shoulder joint. Additionally, a method is needed for attaching sutures to the scapula securely.